Test form

ACME Insurance Services Claim Info Request (DEMO) (1)

Fill in the following information on your damaged car to receive an estimate from the body shop within 4 hours during working hours otherwise you will receive it the following business day.

Claim Number

Name*

Please provide your name.

FirstLast

Phone

Please provide your telephone number (optional)

Email*

Please provide your email address so we can reply back with an estimate on your damaged car.

Enter EmailConfirm Email

Year*

What is the year of your car?

Make*

What is the make of your car?

Model*

What is the model of your car?

Color*

What is the color of your car?

Vehicle Identification Number (VIN)

Please enter your VIN number from you car which you can find in the lower left area of your windshield, as well as your car registration card and/or insurance card. With the VIN number we can write a more accurate estimate with all the parts and procedures related to the damaged car. NOTE: This is for internal use only. We do not report to any agency.

Upload Images

You can send up to photos of your damaged car. We recommend taking photos at various angles about 3 feet away from the damage on the car so we can more easily understand the damage. Also, please take a photo of the entire side of the car where the damage is located. Note: Each image file size cannot exceed 8MB so you may need to resize your image before sending it in.

Front Bumper

Accepted file types: jpg, jpeg, gif, png.

Hood

Accepted file types: jpg, jpeg, gif, png.

Right Fender

Accepted file types: jpg, jpeg, gif, png.

Left Fender

Accepted file types: jpg, jpeg, gif, png.

Left Front Door

Accepted file types: jpg, jpeg, gif, png.

Right Front Door

Accepted file types: jpg, jpeg, gif, png.

Left Rear Door

Accepted file types: jpg, jpeg, gif, png.

Right Rear Door

Accepted file types: jpg, jpeg, gif, png.

Left Quarter Panel

Accepted file types: jpg, jpeg, gif, png.

Right Quarter Panel

Accepted file types: jpg, jpeg, gif, png.

Trunk / Liftgate Panel

Accepted file types: jpg, jpeg, gif, png.

Rear Bumper Cover

Accepted file types: jpg, jpeg, gif, png.

VIN

This photo is the Vehicle Identification Number (VIN) of your car. The VIN is located in a few places around your car, most notable on the driver door or the lower portion of your windshield on the driver side.

Accepted file types: jpg, jpeg, gif, png.

Odometer

This photo is the odometer of your car, showing mileage of your vehicle.

Accepted file types: jpg, jpeg, gif, png.

Dash

This photo is the front instrument cluster dash in your car.

Accepted file types: jpg, jpeg, gif, png.

License Plate

This photo is the license of your car.

Accepted file types: jpg, jpeg, gif, png.

Photo of Damage (First Angle)

Take a photo from 3 feet away from the car. This photo is of the specific damage on your car.

Accepted file types: jpg, jpeg, gif, png.

Photo of Damage (Second Angle)

Take a photo from 3 feet away from the car. This photo is of a different angle on the specific damage on your car.

Accepted file types: jpg, jpeg, gif, png.

Photo of Damage (Third Angle)

Take a photo from 3 feet away from the car. This photo is of a different angle on the specific damage on your car.

Accepted file types: jpg, jpeg, gif, png.

Damage Description

Please provide some information about the damage on your car to make it easier for us to understand and write an estimate on your car.

TRUTH AND ACCURACY ACKNOWLEDGEMENT*

By submitting this claim, I attest that the information, including photos are truthful and accurate to the best of my ability.